Basic Information
| Provider Information | |||||||||
| NPI: | 1538153374 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON HEALTH CARE CENTER OF CHICAGO RIDGE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 665 W NORTH AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601481134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304584700 | ||||||||
| FaxNumber: | 6304584770 | ||||||||
| Practice Location | |||||||||
| Address1: | 10300 SOUTHWEST HWY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604151426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084251100 | ||||||||
| FaxNumber: | 7084250779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 09/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | ROJEK | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6304584780 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 0042739 | IL | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | 0042739 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.